MEDICARE: WILLIAM BUCKLEY SANDERS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070011078	IL

General Provider Information

NPI Number	:	1063577120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BUCKLEY SANDERS PT

Provider Business Mailing Address
First Line	:	6840 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-3425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6840 MAIN ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-3425
Country	:	US
Telephone Number	:	630-275-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	01/29/2021

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